Department of Clinical Neurosciences (M.G., A.G., M.D.H., J.M.O.), University of Calgary, Canada.
Department of Radiology (M.G., M.D.H.), University of Calgary, Canada.
Stroke. 2021 May;52(5):1929-1936. doi: 10.1161/STROKEAHA.120.033984. Epub 2021 Apr 8.
Infarct volume in acute ischemic stroke is closely linked with clinical outcome, with larger infarct volumes being associated with a worse prognosis. Small iatrogenic infarcts, which can occur as a result of surgical or endovascular procedures, are often only seen on diffusion-weighted MR imaging. They often do not lead to any overtly appreciable clinical deficits, hence the term covert or silent infarcts. There is relative paucity of data on the clinical impact of periprocedural hyperintense diffusion-weighted MR imaging lesions, partly because they commonly remain undiagnosed. Clearly, a better understanding of iatrogenic periprocedural diffusion-weighted MR imaging lesions and their clinical significance is needed. In this article, we describe the current limitations of our understanding of the significance of iatrogenic diffusion-weighted MR imaging lesions using exemplary data from the ENACT trial (Safety and Efficacy of NA-1 in Patients With Iatrogenic Stroke After Endovascular Aneurysm Repair) and outline a framework for how to investigate their clinical impact.
在急性缺血性脑卒中患者中，梗死体积与临床预后密切相关，梗死体积越大，预后越差。小的医源性梗死，可能是由于手术或血管内治疗引起的，通常只能在弥散加权磁共振成像上看到。它们通常不会导致明显的临床缺损，因此称为隐匿性或无症状性梗死。关于围手术期高信号弥散加权磁共振成像病变的临床影响的数据相对较少，部分原因是这些病变通常未被诊断。显然，需要更好地了解医源性围手术期弥散加权磁共振成像病变及其临床意义。在本文中，我们使用来自 ENACT 试验（NA-1 在血管内动脉瘤修复术后医源性卒中患者中的安全性和疗效）的示例数据，描述了我们对医源性弥散加权磁共振成像病变意义的理解的局限性，并概述了如何研究其临床影响的框架。
